Anesthesiology pp 189-198 | Cite as

Anesthesia for Colonoscopy

  • George A. DumasEmail author


Sedation and management strategies are discussed for colonoscopy. Specific pre-procedure assessment and anesthetic concerns are addressed. Anesthetic agents used for sedation during colonoscopy are discussed in detail. Also, complications related to the colonoscopy procedure and the sedation used for colonoscopy are examined. After reading this chapter, the anesthesia provider will have a good understanding of what is required during anesthetic management for colonoscopy. They will also be able to anticipate both common and uncommon complications during colonoscopy. Table 20.1 provides a summary of anesthesia considerations in patients undergoing colonoscopy.


Colonoscopy Sedation Aspiration Deep sedation Propofol Colonoscopy complications 


  1. 1.
    American Society of Anesthesiologists; Quality Management and Departmental Administration. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia [Internet]. 2014 [updated 2014 Oct 15; cited 2017 Mar 1].
  2. 2.
    American Society of Anesthesiologists; Quality Management and Departmental Administration. Statement on Safe Use of Propofol [Internet]. [updated 2014 Oct 15; cited 2017 Mar 1].
  3. 3.
    Cooper GS, Kou TD, Rex DK. Complications following colonoscopy with anesthesia assistance: a population-based analysis. JAMA Intern Med. 2013;173(7):551–6. Scholar
  4. 4.
    Agostoni M, Fanti L, Gemma M, Pasculli N, Beretta L, Testoni PA. Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience. Gastrointest Endosc. 2011;74(2):266–75. Scholar
  5. 5.
    Marco G, Laura P, Alessandro O, Massimo A, Francesca P, Barbara R, et al. Swallowing impairment during propofol target-controlled infusion. Anesth Analg. 2016;122(1):48–54. Scholar
  6. 6.
    Rimaniol JM, D’Honneur G, Duvaldestin P. Recovery of the swallowing reflex after propofol anesthesia. Anesth Analg. 1994;79(5):856–9.CrossRefPubMedGoogle Scholar
  7. 7.
    D’Honneur G, Rimaniol JM, el Sayed A, Lambert Y, Duvaldestin P. Midazolam/propofol but not propofol alone reversibly depress the swallowing reflex. Acta Anaesthesiol Scand. 1994;38(3):244–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. Br J Anaesth. 1999;83(3):453–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Choi NK, Lee J, Chang Y, Jung SY, Kim YJ, Lee SM, et al. Polyethylene glycol bowel preparation does not eliminate the risk of acute renal failure: a population-based case-crossover study. Endoscopy. 2013;45(3):208–13. Scholar
  10. 10.
    Qureshi WA, Zuckerman MJ, Adler DG, Davila RE, Egan JV, Gan SI, et al. ASGE guideline: modifications in endoscopic practice for the elderly. Gastrointest Endosc. 2006;63(4):566–9. Scholar
  11. 11.
    Bucci C, Rotondano G, Hassan C, Rea M, Bianco MA, Cipolletta L, et al. Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc. 2014;80(4):566–76.e2. Scholar
  12. 12.
    Huffman M, Unger RZ, Thatikonda C, Amstutz S, Rex DK. Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study. Gastrointest Endosc. 2010;72(3):516–22. Scholar
  13. 13.
    Slivka A, Bosco JJ, Barkun AN, Isenberg GA, Nguyen CC, Petersen BT, et al. Electrosurgical generators: MAY 2003. Gastrointest Endosc. 2003;58(5):656–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Langeron O, Masso E, Huraux C, Guggiari M, Bianchi A, Coriat P, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92(5):1229–36.CrossRefPubMedGoogle Scholar
  15. 15.
    El-Orbany M, Woehlck HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870–80. Scholar
  16. 16.
    Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology. 2009;110(4):891–7. Scholar
  17. 17.
    Chatman N, Sutherland JR, van der Zwan R, Abraham N. A survey of patient understanding and expectations of sedation/anaesthesia for colonoscopy. Anaesth Intensive Care. 2013;41(3):369–73.PubMedGoogle Scholar
  18. 18.
    Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116(15):1736–54. Scholar
  19. 19.
    Allen M, Leslie K, Hebbard G, Jones I, Mettho T, Maruff P. A randomized controlled trial of light versus deep propofol sedation for elective outpatient colonoscopy: recall, procedural conditions, and recovery. Can J Anaesth. 2015;62(11):1169–78. Scholar
  20. 20.
    Goudra B, Singh PM, Gouda G, Borle A, Carlin A, Yadwad A. Propofol and non-propofol based sedation for outpatient colonoscopy-prospective comparison of depth of sedation using an EEG based SEDLine monitor. J Clin Monit Comput. 2016;30(5):551–7. Scholar
  21. 21.
    Training Committee. American Society for Gastrointestinal Endoscopy. Training guideline for use of propofol in gastrointestinal endoscopy. Gastrointest Endosc. 2004;60(2):167–72.CrossRefGoogle Scholar
  22. 22.
    McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008;67(6):910–23. Scholar
  23. 23.
    Singh H, Poluha W, Cheung M, Choptain N, Baron KI, Taback SP. Propofol for sedation during colonoscopy. Cochrane Database Syst Rev. 2008;8(4):CD006268. Scholar
  24. 24.
    Padmanabhan U, Leslie K, Eer AS, Maruff P, Silbert BS. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. Anesth Analg. 2009;109(5):1448–55. Scholar
  25. 25.
    Tuncali B, Pekcan YO, Celebi A, Zeyneloglu P. Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for colonoscopy: a randomized, double-blind, controlled trial. J Clin Anesth. 2015;27(4):301–6. Scholar
  26. 26.
    Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77(6):1134–42.CrossRefPubMedGoogle Scholar
  27. 27.
    Jalowiecki P, Rudner R, Gonciarz M, Kawecki P, Petelenz M, Dziurdzik P. Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy. Anesthesiology. 2005;103(2):269–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Dere K, Sucullu I, Budak ET, Yeyen S, Filiz AI, Ozkan S, et al. A comparison of dexmedetomidine versus midazolam for sedation, pain and hemodynamic control, during colonoscopy under conscious sedation. Eur J Anaesthesiol. 2010;27(7):648–52. Scholar
  29. 29.
    Westmoreland CL, Hoke JF, Sebel PS, Hug CC Jr, Muir KT. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology. 1993;79(5):893–903.CrossRefPubMedGoogle Scholar
  30. 30.
    Manolaraki MM, Theodoropoulou A, Stroumpos C, Vardas E, Oustamanolakis P, Gritzali A, et al. Remifentanil compared with midazolam and pethidine sedation during colonoscopy: a prospective, randomized study. Dig Dis Sci. 2008;53(1):34–40. Scholar
  31. 31.
    Hong MJ, Sung IK, Lee SP, Cheon BK, Kang H, Kim TY. Randomized comparison of recovery time after use of remifentanil alone versus midazolam and meperidine for colonoscopy anesthesia. Dig Endosc. 2015;27(1):113–20. Scholar
  32. 32.
    Theodorou T, Hales P, Gillespie P, Robertson B. Total intravenous versus inhalational anaesthesia for colonoscopy: a prospective study of clinical recovery and psychomotor function. Anaesth Intensive Care. 2001;29(2):124–36.PubMedGoogle Scholar
  33. 33.
    Syaed El Ahl MI. Modified sevoflurane-based sedation technique versus propofol sedation technique: a randomized-controlled study. Saudi J Anaesth. 2015;9(1):19–22. Scholar
  34. 34.
    Welchman S, Cochrane S, Minto G, Lewis S. Systematic review: the use of nitrous oxide gas for lower gastrointestinal endoscopy. Aliment Pharmacol Ther. 2010;32(3):324–33. Scholar
  35. 35.
    Aboumarzouk OM, Agarwal T, Syed Nong Chek SA, Milewski PJ, Nelson RL. Nitrous oxide for colonoscopy. Cochrane Database Syst Rev. 2011;(8): CD008506.
  36. 36.
    Martin JP, Sexton BF, Saunders BP, Atkin WS. Inhaled patient-administered nitrous oxide/oxygen mixture does not impair driving ability when used as analgesia during screening flexible sigmoidoscopy. Gastrointest Endosc. 2000;51(6):701–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Cirocco WC, Rusin LC. Factors that predict incomplete colonoscopy. Dis Colon Rectum. 1995;38(9):964–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol. 2000;95(10):2784–7. Scholar
  39. 39.
    Waye JD. Completing colonoscopy. Am J Gastroenterol. 2000;95(10):2681–2. Scholar
  40. 40.
    Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54(5):558–62.CrossRefPubMedGoogle Scholar
  41. 41.
    Witte TN, Enns R. The difficult colonoscopy. Can J Gastroenterol. 2007;21(8):487–90.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Korman LY, Haddad NG, Metz DC, Brandt LJ, Benjamin SB, Lazerow SK, et al. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc. 2014;79(4):657–62. Scholar
  43. 43.
    Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management. Gastrointest Endosc Clin N Am. 2010;20(4):659–71. Scholar
  44. 44.
    Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc. 2007;66(1):27–34. Scholar
  45. 45.
    Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150(12):849–57, w152CrossRefPubMedGoogle Scholar
  46. 46.
    Adeyemo A, Bannazadeh M, Riggs T, Shellnut J, Barkel D, Wasvary H. Does sedation type affect colonoscopy perforation rates? Dis Colon Rectum. 2014;57(1):110–4. Scholar
  47. 47.
    Levin TR, Zhao W, Conell C, Seeff LC, Manninen DL, Shapiro JA, et al. Complications of colonoscopy in an integrated health care delivery system. Ann Intern Med. 2006;145(12):880–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA, et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. Clin Gastroenterol Hepatol. 2010;8(2):166–73. Scholar
  49. 49.
    Fisher DA, Maple JT, Ben-Menachem T, Cash BD, Decker GA, Early DS, et al. Complications of colonoscopy. Gastrointest Endosc. 2011;74(4):745–52. Scholar
  50. 50.
    Ko CW, Riffle S, Shapiro JA, Saunders MD, Lee SD, Tung BY, et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007;65(4):648–56. Scholar
  51. 51.
    Wong JC, Yau KK, Cheung HY, Wong DC, Chung CC, Li MK. Towards painless colonoscopy: a randomized controlled trial on carbon dioxide-insufflating colonoscopy. ANZ J Surg. 2008;78(10):871–4. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineUniversity of Alabama at BirminghamBirminghamUSA

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